Which patient may benefit the most from penile prosthesis implantation?

Autor: La Croce G; Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy., Schifano N; Department of Urology, Circolo & Fondazione Macchi Hospital, University of Insubria, Varese, Italy., Pescatori E; Andrology Service, Hesperia Hospital, Modena, Italy., Caraceni E; Department of Urology, Area Vasta 3 Asur Marche, Civitanova Marche, Italy., Colombo F; Andrology Unit, Sant'Orsola University Hospital, University of Bologna, Italy., Bettocchi C; Department of Urology, University of Bari, Bari, Italy., Carrino M; Department of Urology, AORN Antonio Cardarelli, Naples, Italy., Vitarelli A; Department of Urology, University of Bari, Bari, Italy., Pozza D; Studio di Andrologia e di Chirurgia Andrologica, Rome, Italy., Fiordelise S; Andrology Unit, ASL di Piacenza, Piacenza, Italy., Varvello F; Department of Urology, S. Lazzaro Hospital, Alba, Italy., Paradiso M; Department of Urology, Ospedale Cardinal Massaia, Asti, Italy., Silvani M; Department of Urology, Ospedale di Biella, Biella, Italy., Mondaini N; Department of Urology, Villa Donatello Hospital, Florence, Italy., Natali A; Department of Urology, Careggi Hospital, University of Florence, Florence, Italy., Falcone M; Urology Clinic, Città della Salute e della Scienza, University of Turin, Turin, Italy., Ceruti C; Urology Clinic, Città della Salute e della Scienza, University of Turin, Turin, Italy., Salonia A; Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy., Antonini G; Antonini Urology, Rome, Italy., Cai T; Department of Urology, Santa Chiara Regional Hospital, Trento, Italy., Palmieri A; Department of Neurosciences, Reproductive Sciences, Odontostomatology, University of Naples Federico II, Naples, Italy., Dehò F; Department of Urology, Circolo & Fondazione Macchi Hospital, University of Insubria, Varese, Italy., Capogrosso P; Department of Urology, Circolo & Fondazione Macchi Hospital, University of Insubria, Varese, Italy.
Jazyk: angličtina
Zdroj: Andrology [Andrology] 2022 Nov; Vol. 10 (8), pp. 1567-1574. Date of Electronic Publication: 2022 Sep 26.
DOI: 10.1111/andr.13294
Abstrakt: Background: Penile prosthesis implantation has been associated with overall good functional outcomes. Of relevance, some patients reported higher level of satisfaction and quality of life.
Aim: We investigated the profile of the patients who may benefit the most from penile prosthesis implantation.
Materials and Methods: Data from a national multi-institutional registry of penile prostheses including patients treated from 2014 to 2017 in Italy (Italian Nationwide Systematic Inventarization of Surgical Treatment for Erectile Dysfunction) were analyzed. All data have been prospectively recorded by 45 surgeons on a dedicated website (www.registro.andrologiaitaliana.it) and revised by a single data manager. Patients' baseline characteristics were recorded. In order to simultaneously evaluate perceived penile prosthesis function and quality of life, all patients were re-assessed at 1-year follow-up using the validated questionnaire Quality of Life and Sexuality with Penile Prosthesis. High quality of life after surgery was defined as a score higher than the 75th percentile in each of the subdomains of the Quality of Life and Sexuality with Penile Prosthesis questionnaire. Logistic regression analysis tested the association between clinical characteristics and high quality of life after penile prosthesis implantation.
Results: Follow-up data were available for 285 patients (median age 60 years; interquartile range: 56-67) who underwent penile prosthesis implantation. Erectile dysfunction etiology was organic in 40% (114), pelvic surgery/radiotherapy in 39% (111), and Peyronie's disease in 21% (60) of the cases. Patients showed good overall Quality of Life and Sexuality with Penile Prosthesis scores at 1-year follow-up for functional (22/25), personal (13/15), relational (17/20), and social (13/15) domains. Overall, 27.0% (77) of patients achieved scores consistent with the high quality of life definition. These patients did not differ in terms of median age (60 vs. 62), type of prosthesis (inflatable penile prostheses: 95% in both of the cases), and post-operative complications (10% vs. 14%) than those with lower quality of life score (all p > 0.1). At logistic regression analysis, erectile dysfunction etiology was the only factor independently associated with high quality of life at 1 year after surgery (p = 0.02). Patients treated for Peyronie's disease (odds ratio: 2.62; p = 0.01; 95% confidence interval: 1.20-5.74) were more likely to report better outcomes after accounting for age, post-operative complications, and surgical volume.
Conclusion: Penile prosthesis implantation is associated with an overall good quality of life. The subset of patients affected by erectile dysfunction secondary to Peyronie's disease seemed to benefit the most from penile prosthesis implantation in terms of functional outcomes, relationship with their partners and the outside world, and perceived self-image. The systematic use of validated questionnaires specifically addressed at evaluating quality of life and satisfaction after penile prosthesis implantation should be further implemented in future studies to better define the predictors of optimal satisfaction after penile prosthesis implantation.
(© 2022 American Society of Andrology and European Academy of Andrology.)
Databáze: MEDLINE
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